At Rebalance Physical Therapy, we frequently encounter patients who present with pain on the ulnar side of the wrist, often diagnosed as a TFCC (Triangular Fibrocartilage Complex) tear or sprain. The TFCC is a crucial structure that supports and stabilizes the wrist, especially on the pinky side, cushioning bones during impacts and stabilizing the wrist during rotational movements. Tears or injuries to the TFCC can cause pain, clicking, popping, and tenderness in this area. Typically, such injuries are confirmed through MRI or CT scans and are treated with braces, splints, and therapy. Severe cases might even require surgery.
But what if you’ve been diagnosed with a TFCC issue, followed the prescribed treatment, and yet the pain persists? Or what if imaging shows no TFCC damage despite similar symptoms? Today, we explore a lesser-known cause of wrist pain that mimics TFCC issues: the Deep Back Arm Line.
Understanding the Deep Back Arm Line
The Deep Back Arm Line is a complex network of muscles and fascia that includes:
- Levator Scapulae: Attaches to the upper cervical vertebrae.
- Rhomboids: Connect the spine to the shoulder blades.
- Rotator Cuff Muscles: Supraspinatus, Infraspinatus, Teres Minor, Subscapularis.
- Triceps Brachii: Muscle at the back of the upper arm.
- Fascia: Connective tissue along the underside of the ulna on the pinky side of the forearm.
- Hypothenar Muscles: On the pinky side of the palm.
This fascial chain helps move and stabilize the head, shoulder blade, shoulder, and arm. When dysfunctional, it can become tight, contracted, or adhered, leading to a range of symptoms.
Signs of Deep Back Arm Line Dysfunction
If the Deep Back Arm Line is tight, you might experience:
- Neck Stiffness or Headaches: Tightness at the top of the fascial chain may cause rotation limitations and associated headaches or neck discomfort.
- Shoulder Blade Issues: An elevated, tipped, or rounded shoulder blade indicates tightness from the Levator Scapulae and Rotator Cuff muscles.
- Elbow Restrictions: Difficulty with full elbow extension or flexion, or symptoms resembling “Tennis Elbow.”
- Wrist Pain and Numbness: Pain, tightness, or numbness on the pinky side of the wrist, hand, and fingers.
Five Tests to Assess Deep Back Arm Line Dysfunction
- Cervical Rotation: Rotate your head towards the side of discomfort. Restricted movement can indicate tightness in the Deep Back Arm Line.
- Opposite Shoulder Tap: Reach up and around the back of your head to touch the opposite shoulder. Difficulty or pain during this movement suggests tightness or restriction.
- Maximal Elbow Flexion: Bend your elbow and attempt to touch the tip of your thumb to the front of your shoulder. Pain or difficulty completing this movement can reveal issues in the back of your arm.
- Wrist Pronation: Bend your elbows, hold a “thumbs up” position, and rotate them to point at each other. If one wrist feels different or painful compared to the other, it may indicate tightness.
- Upside Down Hand Goggles: Create “goggles” with your thumb and index finger, tipping the rest of your arm back. Compare sensations side by side. If this position reproduces any symptoms near the TFCC area, it may point to a Deep Back Arm Line issue.
If conventional treatments for TFCC pain haven’t resolved your symptoms, a movement specialist can assess if the Deep Back Arm Line is contributing to your discomfort. At Rebalance Physical Therapy, we offer interventions such as dry needling, myofascial release, and targeted stretching and strengthening to address these dysfunctions effectively.
For a comprehensive evaluation and tailored treatment plan, consider scheduling a session with us. Let’s work together to get you back to enjoying your favorite activities without pain.
Feel free to reach out if you have any questions or need further assistance!
Stay Active, Stay Healthy!
